Ginnie and Adamo,

I know what you are saying. It seems unlikely as a true physical withdrawal symptom, but with a psychosomatic component in play it could be part of the picture; I've seen some reports of "flu-like symptoms" during benzo suspension on the net so clearly the experience is not unique.

I have not, however, seen these symptoms listed in what I consider reputable sources such as the Ashton manual.

Wikipedia lists "flu-like symptoms" but their reference is an article on the use of flumazenil during withdrawal... I cannot access the full text, but the abstract makes no mention of flu-like symptoms. I can't help thinking the person who added the "flu-like symptoms" to the Wiki entry either did not have a solid reference and tried to be crafty, or was genuinely confused about what flumazenil does, because of the name.

In any event, the presence of a fever always warrants investigation as it may signal an infection. A high fever should never be left uncontrolled.

waves

After 4+ days of agonizing c/t from .75mg Kpin with incredible consistent insomnia, violent physical shaking, insane anxiety and akathisia I decided to go to ER because my B/P & heart rate were exceedingly high. They spoke to my primary care doctor (who it turns out is an expert on Kpin tapering) and wrote me a script for 20 .5 mgs. I reinstated the .75 from last Wednesday and want to go aggressively forward and taper off by the end of the month. What do you think would be the best strategy to get from .75 now to 0 in 2-3 weeks?

Honestly, when I was in ER I first refused a 1mg Ativan shot and asked the doctor if I should stick it out being it was my fifth day in C/T off .75 and would be worse off reinstating. He thought that as bad as I was and as sleepless as I was he asked if I could take another 5-10 like the last 4 and wondered if that would result in recovery or just downright disability and indigence for an extended time afterwards? So I went with the ER. My former psyche said that any reinstatement would unquestionably result in long-term use and increasing of dosage leading to tolerance — as if 7-8 weeks wasn't already fairly long-term anyway. If I had continued as I was I was so animalistic I was scaring people: moaning, shaking, unable to sit still, bent over, etc. Whatever the case I still feel like a BIG COWARD for not sticking it out another 5 days to get through the worst — but would I have been better off? They had told me that stopping C/T off .75 mg would be bearable because I had already tapered for 2 weeks from 2mg to .75mg. HA!

Adamo,

I am glad you got medical attention. And now you know your PCP can and will help you with the Klonopin, going forward. You have more pills, for starters.

You have asked me for advice with a deadline. You have been placing yourself before deadlines up until now. I ask you: how has that been working for you?

My advice, fwiw, is as follows:

First things first. Feel better. Stay at 0.75 mg until you feel relatively ok.

At that point, contact your PCP and talk to him about the next step. I would decrease by steps of no more than 0.25 mg at a time. (As I've said before, I personally think half that would be better.)

Anyway, it sounds like your PCP is going to be of more help, realistically speaking, than the addiction expert. This is good.

Good job getting things straightened out. How are you feeling now?

waves

I took the .75 mg in the morning at ER. It took a good 90 minutes for me to calm down. I kinda of feel a bit worse now that it has worn off — I fear I have put a spike into the cold turkey process not waiting it out. Unfortunately, I was awoken at 5 AM yesterday to take my 84 year old father to the hospital with chest pains (he has pace maker). I spent 8 hours with him there and flipped out until this morning awaiting the blood tests to see if it had been a heart attacK which it turned out not to be. I think that stress turned me into such a madman that when I picked him up 24 hours later at the hospital the people there saw how bad I was shaking and moaning and wanted to check me in!

I was led to believe that if I just kept on with the cold turkey by 7-10 days I'd be better but I failed — but even the ER guy said that cutting from .75 to zero which I had only been at for 7 days is TOO EXTREME! I took .75 mg today and no more just to reinstate from last Wednesday. If I reduce .25mg at a time how long should I stay at this 1 week? 10 days?

My PCP wants to take me off using phenobarbital. Is this acceptable given my 2 months' use and the the .75 I'm on? Is it effective or dangerous?

Much obliged to you for your opinion.

Good grief! Phenobarbital?

Talk about jumping from the frying pan into the fire.

I apologize, but no, please, please...

The fact that it is sedating might be attractive to you, but it will likely impair your ability to drive (and think) a good bit more than the Klonopin. For the rest, it is just as "addictive" and has more interactions.

Seriously. I encourage you to simply ask the doctor for his support reducing the Klonopin as slowly as you need to, without adding other medicines.

Down by 0.25 mg every ten days should be ok. You could even try every week if you feel comfortable, but I'd just plan on seeing how it goes. I would not go any faster than one reduction per week (7 days).

You managed a lot of stress, despite your condition, with what you went through with your father. Kudos to you, and I am glad your dad did not have a heart attack. Is he alright?

waves

My PCP said this was his way NOT prescribing more Kpin. So if I have script for 20 .5mg conceivably I could start with .75 mg for a little while go to .5 for a week, and .25 for a week, to .125, etc. Or should I just start at .5 for sleep, then to .25, then to .125, to 0?

I'd not heard of people being taken off benzo's with phenobarbital before -- only the use of a long-acting benzo (eg. Valium). However, a quick google revealed that there is indeed some literature to support phenobarbital substitution as a withdrawal strategy.

Eg: http://www.ncbi.nlm.nih.gov/pubmed/1575069

The major bone I have with this strategy, in your case, is that you've just been through no small amount of trouble with these substances, first with gabapentin, and now with Klonopin. As such, I'm skeptical about introducing yet a THIRD medication which causes dependence, and from which in turn you'll have to be weaned after the substitution phase.

Furthermore, substitutions in and of themselves are not seamlesss, because different drugs have different properties. This is true even when substituting one benzo for another. After the Klonopin has been entirely removed and phenobarbital put in its place, you'd have to commence the gradual suspension of the phenobarbital.

waves

I'm thinking that breaking 0.5's into quarters might not be the best thing at this point in the reduction, where you'd only be taking the bits of pill. I use very precise doses when I taper. Unfortunately, you don't have anyone to prescribe the 0.125 mg wafers. 0.25 decrements should be ok though, provided there's a decent amount of time between reductions.

It makes me angry when I think how easily they dish out potent drugs like Klonopin, and then refuse to help people come off them.

If you feel ok about reducing on your own, here is my non-professional suggestion:

1. Days 1-10 (start day contingent on feeling able, getting some sleep), 0.5 mg.

2. Days 11-20, 0.25 mg.

3. Day 21, stop.

This isn't a very aggressive schedule, but it is hardly conservative, either.

Some questions, based on the answers to which I might make additional suggestions or alter the above suggestion:

1. How much Klonopin do you actually have at your disposal, total, as of now?
2. How many days were you abstinent (0 mg)?
3. How many doses of 0.75 mg did you do, following the abstinent period?
4. Are you taking it all in the evening, or in divided doses at this point?
5. How are you feeling right before it's time to take the daily dose, or if divided, right before the larger dose?

waves

I have no pills except for the 20 .5mg I am getting by ER script. I took .75 for one week then stopped completely for 5 days before I took .75 yesterday at ER. Taking in the evening. By the time I got to yesterday morning I was in dire trouble and even this morning I am so nervous and agitated I am totally incapable and can't stop shaking. I slept last night but that because I had taken .75 in the ER yesterday morning and hadn't slept for the two nights before that and I mean I was so agitated and sleepless at night that it was unbearable! In the day I am extremely agitated, anxious, and shaking violently. I am terrified of this reinstatement without supervision. Will I be in deeper trouble by 20 days from now without any recourse for more pills? With no supervision will I stand a chance? Or should I instead restart with the cold turkey for another 5 days? Wouldn't that just really mess me up for a long time to come? And reinstatement after 10 days might make things worse!

Really feel as if I am in danger of destroying any chance I have of recovery. The psych originally warning me if I tried to go on any slower reduction "if I wanted to be off benzo and I would be taking Kpin for a long time." There is no way to tell if I will be in even more severe withdrawal if I go and take another 20 days of Kpin and I feel like I am looking down the barrel of a gun!

Please do not go cold turkey again. The ER doctor saw you. He would not have given you the Klonopin if he felt you could/should ride it out. Use the pills you have at your disposal to d/c gradually. They will be enough.

I am unclear on a couple of points.

Question 1. As of right now, do you still have a total of 20 x 0.5 mg Klonopin pills?

Question 2. Yesterday you took 0.75mg in the morning at the ER, ok. Did you then take another dose in the evening? If so, how much?

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That same doc thought you could go cold turkey from 0.75 and how did that work out?

I see her reasoning as profoundly flawed, insoftar as one does not become dependent overnight, it is a gradual process. Anyway, worrying about this stuff is only going to raise your anxiety level -- bad idea. Please, put aside the "what ifs", and go forward. You have three choices:

1) cold turkey
2) taper with 20 pills and
3) have your GP oversee you with phenobarbital

If you want to be supervised your only choice is 3). I've already stated what I feel would be safest and sanest -- the taper. Apparently the ER doc expected something like this too, or would not have given you 20 pills.

I did not think going from 0.75 to zero was a good idea, but I didn't see you and did not want to discourage you if the doctor thought it was ok. Well, this other doctor (at ER) did see you, did not think it was ok, and gave you some pills to help you out. I think what he did was sensible. You have enough to d/c safely. You might have some discomfort but it won't be nearly as bad as it has been the past few days.

The dependence is not going to worsen, as your blood levels are falling as we speak. The abstinence of 5 days has already made your levels drop off significantly.

You can look at the 0.75mg as a rescue dose in dire circumstances -- it is not a reinstatement. It will not have worsened your dependence because a single dose cannot bring your levels back up anywhere close to where they were before.

I think your best bet is to resume or "reinstate" at 0.5 mg as of tonight. If you didn't take any last night, you can take tonight's dose a little early. As of tomorrow, take it at the time you'd normally take it in the evening.

You WILL be ok!!!

waves